Washington Medicaid Planning: What Families Need to Know

When a parent or spouse in Washington needs nursing-home or in-home long-term care, Washington Apple Health can help pay for it. Eligibility depends on a $2,000 resource standard for a single person (2026), an income test, a 60-month review of past transfers, and separate rules that let a spouse at home keep part of the couple's savings and income.

This page sets out how Washington's long-term-care Medicaid rules treat the resource standard, income, the home, a spouse at home, past transfers and estate recovery, using the state's own figures and the dates they apply from.

What Washington's Medicaid Long-Term Care Program Covers

Washington's Medicaid program is called Washington Apple Health. Long-term care falls under what the Washington State Health Care Authority (HCA) calls long-term services and supports (LTSS). According to the HCA's long-term care page, home and community based services help people keep living at home. Examples the HCA names include the Home and Community Services (HCS) and Developmental Disabilities Administration (DDA) waivers and Community First Choice (CFC). When needs cannot be met at home, care in a residential or nursing facility is available.

Two tests, not one. A person must meet both the financial requirements and a comprehensive functional assessment. The financial side is what most of this page covers. The functional side looks at the person's care needs; services begin once nursing facility level of care is determined, as the application section below explains.

Who decides. For people over 65, people receiving Medicare, and people receiving LTSS, eligibility decisions are made by the Department of Social and Health Services (DSHS).

This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.

Washington Medicaid Eligibility: Asset Limits and Countable vs. Exempt Property

The resource standard. Washington's administrative code defines the "resource standard" as the most a person can own and still qualify. A countable asset is any resource the state counts toward that limit. An exempt asset is property the state does not count. Under the Washington resource-standard rule, the standard is $2,000 for a single person and $3,000 for a legally married couple, with exceptions. The $3,000 couple standard does not apply when both spouses are institutionalized: each is then determined as a single person the month after separation. When one spouse stays at home, the community spouse allocation described in the next section applies. The HCA standards chart lists medically needy resource standards dated January 1, 2026 that begin at $2,000 for one person and $3,000 for two.

Exempt property. Not everything a person owns counts toward the standard. Washington's rules separate countable resources from excluded ones, with separate rules for property and contracts, vehicles, life insurance, and burial funds, contracts and spaces. One home is excluded only if it meets the home equity limit, covered below.

Income. Income is tested separately. Washington's Special Income Level is $2,982 a month as of January 1, 2026. The HCA describes it as 300% of the federal benefit rate. According to the HCA's medically needy page, a person living in a medical institution whose income is above that level may still qualify for institutional services under the medically needy program, within the limits that page describes.

The home. Federal law bars long-term-care coverage when home equity is above a set limit, unless a spouse, a child under 21, or a blind or disabled child lives in the home. Washington's excess home equity limit is the federal maximum: $1,130,000 as of January 1, 2026. It applies to LTSS applications received on or after May 1, 2006. A person who is denied for excess home equity may apply for an undue hardship waiver.

The Community Spouse: What a Husband or Wife at Home Keeps in Washington

Who counts as the community spouse. The community spouse is the husband or wife who stays at home while the other spouse receives institutional-level care. For that spouse, the question is less about eligibility and more about whether the household can keep running.

The federal framework. Federal law, 42 U.S.C. § 1396r-5, first adds up both spouses' resources and takes half as the "spousal share." It then lets the community spouse keep a community spouse resource allowance (CSRA). The statute's own dollar amounts for that allowance are subject to adjustment, so the current figures appear below.

Washington's allocation. Under the Washington allocation rule, when the institutionalized spouse's most recent continuous period of institutionalization began on or after August 1, 2003, the state allocates the greater of two amounts to the community spouse:

• half the couple's combined countable resources, up to the federal spousal resource maximum, or
• the state spousal resource standard.

The HCA chart gives the federal maximum as $162,660 (January 1, 2026) and the state standard as $72,529 (July 1, 2025; it changes in odd years). The allocation can be larger if a court has ordered support for the community spouse. It can also be larger if a hearing order finds that the income from the allocated resources is too low to bring the community spouse up to the monthly maintenance needs allowance.

Monthly income for the spouse at home. The chart lists a community spouse maintenance needs allowance maximum of $4,066.50 (January 1, 2026) and a community spouse and dependent allowance of $2,705 (July 1, 2026).

After approval. The community spouse's resources become unavailable to the institutionalized spouse the month after eligibility is established, with limited exceptions. Families weighing these figures may find the overview of Medicaid planning for married couples useful.

Washington's Look-Back Period and Transfer Penalties

The look-back period. The look-back period is the window before an application during which gifts and other transfers are reviewed. Federally, it is 60 months for transfers made on or after February 8, 2006 (42 U.S.C. § 1396p(c)(1)(B)(i)). The HCA's transfer-of-asset guidance says Washington reviews transfers made within the 60-month period before the month the client attained institutional status and applied for long-term care.

How long a penalty lasts. A penalty period is a stretch of ineligibility caused by a transfer for less than fair market value. Washington takes the uncompensated value of the transfer and divides it by the statewide average daily private nursing-facility cost. It uses the cost at the time of application or the date of transfer, whichever is later. Under the rule the HCA reprints, the result is the length of the penalty in days.

When a penalty starts. Under federal law, a penalty starts on the later of two dates: the month of the transfer, or the date the person is eligible and would otherwise be receiving institutional-level care (42 U.S.C. § 1396p(c)(1)(D)(ii)). A gift made four years ago and a gift made last month are penalized the same way.

Exceptions. Not every transfer is penalized. Federal law allows a home to be transferred to the person's spouse without penalty (42 U.S.C. § 1396p(c)(2)(A)(i)), and transfers to a spouse generally carry no penalty. The HCA lists exceptions including a transfer to the client's disabled child, and transfers shown not to have been made to qualify for Medicaid. How these rules apply when care is already needed is discussed in Medicaid crisis planning.

Planning Tools Washington Families Use: Trusts, Annuities, and Spend-Down

Trusts, annuities and spend-down each come with conditions set by the rules that govern them.

Irrevocable trusts. How a trust affects eligibility depends on the trust's terms and on Washington's current rules.

Annuities. Federal law treats buying an annuity as a transfer for less than fair market value unless the state is named as remainder beneficiary in the first position for at least the total medical assistance paid, or in the second position after the community spouse or a minor or disabled child (42 U.S.C. § 1396p(c)(1)(F)). Separately, for the transfer rules, an annuity bought by or on behalf of someone who has applied for nursing-facility or other long-term-care Medicaid counts as an asset unless one of two conditions is met (42 U.S.C. § 1396p(c)(1)(G)):

• it is an annuity described in section 408(b) or (q) of the Internal Revenue Code, or was purchased with proceeds from certain retirement accounts the statute lists, or
• it is irrevocable, nonassignable and actuarially sound, and pays in equal amounts with no deferral and no balloon payments.

Promissory notes and life estates. Funds used to buy a promissory note, loan or mortgage also count as assets for the transfer rules unless it has an actuarially sound repayment term, equal payments with no deferral and no balloon payments, and a bar on cancelling the balance at the lender's death (42 U.S.C. § 1396p(c)(1)(I)). Buying a life estate in another person's home counts as a transfer unless the buyer lives there for at least one year after the purchase.

Spend-down. Washington's resource rule lets a person reduce excess resources by deducting certain incurred medical expenses, such as health-insurance and Medicare premiums, deductibles, coinsurance and copayments, and medically necessary care that Medicaid does not cover, within the limits the rule sets. Washington's medically needy rules also allow approval despite excess resources in some cases. That happens when income plus excess resources does not exceed the facility's private rate plus recurring medical expenses; the excess is then added to the person's share of the cost of care.

Washington Estate Recovery: What Happens After a Medicaid Recipient Dies

What estate recovery is. Estate recovery is the state's claim for repayment of Medicaid costs from a recipient's property after death.

What Washington recovers. Under Washington's estate recovery statute, for a person who was 55 or older when receiving care, the department seeks recovery from the estate and from nonprobate assets. Recovery is limited to nursing facility services, home and community-based services, other services the department determines appropriate, and related hospital and prescription drug services. The statute also lets the department file liens consistent with federal law; before death, a lien is allowed only if the person is an inpatient in a nursing facility or other medical institution and the department has determined, after notice and an opportunity for a hearing, that the person cannot reasonably be expected to be discharged and return home.

Which rules apply. The law in effect on the date benefits were received governs. Property exempt under federal law or treaty, including tribal artifacts held by individual Native Americans, is excluded.

Deferral and waiver. Federal law defers recovery while a surviving spouse, a child under 21, or a blind or disabled child survives. The deferral delays the claim; it does not cancel it. States must also have procedures to waive recovery when it would cause undue hardship. Washington's statute directs the department to set up those waiver procedures. It also recognizes undue hardship for a surviving domestic partner wherever recovery would not have been allowed against a surviving spouse.

Applying and Appealing in Washington

How applications are made. The HCA lists three ways to apply:

• online through Washington Connection;
• by mailing paper Form 18-005 to DSHS Home and Community Services, PO Box 45826, Olympia, WA 98504-5826; or
• in person at a Home and Community Services office.

When coverage starts. Coverage begins on the first day of the month the application was submitted, if the person is eligible for LTSS that month. Services begin once nursing facility level of care is confirmed and a caregiver is in place.

How appeals work. According to the HCA's hearing guidance, a hearing request must be made within 90 days of the date of the decision. If a request arrives later, an administrative law judge decides whether it is timely. The request can be made verbally or in writing, in any form, to any responsible agency employee. For decisions made by DSHS, written requests can go to places including the Community Services Office of record and the DSHS Customer Service Center, PO Box 11699, Tacoma WA 98411. Requests can also be made by phone or in person.

Dates and Scope: What Changes and What This Page Covers

Why dates matter. The HCA chart gives each figure its own date: some apply from January 1, 2026, the community spouse and dependent allowance shown above from July 1, 2026, and the state spousal resource standard from July 1, 2025, which the chart says changes in odd years. For a related situation, see Medicaid planning for dementia.

What this site is. Medicaid Asset Protection Group is not a law firm. This page does not cover Medicare, private long-term-care insurance, veterans' benefits or tax questions. More on the attorney's role appears in what a Medicaid planning attorney does.

Discussing Medicaid Planning in Washington

To request a consultation about a family's Medicaid and long-term-care options in Washington, contact Medicaid Asset Protection Group.